Since President Obama has been re-elected, I decided that I had better educate myself on the question of the Health Care Reform Act and find out what is really at stake. I do believe that the only way the President will get the support he needs to make this initiative successful is if he and his Administration educate the public with the same energy and coordination that they used for his election and re-election. For my part, I will begin with the history of the universal health care question in our country and move forward.

Many people think that the whole question of universal health care was “pushed” on us by “this” president. Untrue. Universal health care has been a topic of discussion since the turn of the century — the 20th century. Yes, since the early 1900s. Why is it that the idea of universal health care has not been embraced by our country, the only advanced nation in the world not to have universal health care? The answer to that question has many components. Jill Lepore, in an article she penned December 7, 2009 for the New Yorker, wrote that a group of economists which included Louis Brandeis, Jane Addams and Woodrow Wilson formed a committee they called the Committee on Social Insurance. By 1915, the committee had drafted a bill to provide universal medical coverage. At the time, the American Medical Association enthusiastically supported the idea and by the end of 1916, the idea was presented to Congress for their approval.

According to Lepore, part of their presentation lauded Germany as the great example to be emulated.

“Germany showed the way in 1883,” Fisher [one of the committee members] told his audience. “Her wonderful industrial progress since that time, her comparative freedom from poverty . . . and the physical preparedness of her soldiery, are presumably due, in considerable measure, to health insurance.”

However, in April 1917, the United States declared war with Germany, killing, along with some German soldiers, any move towards Universal Health Care which was now being correlated as a product of Germany.

In Lepore’s article, we learn that:

In California, where the legislature had passed a constitutional amendment providing for universal health insurance, it was put on the ballot for ratification: a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it “would spell social ruin to the United States.” Every voter in the state received in the mail a pamphlet with a picture of the Kaiser and the words “Born in Germany. Do you want it in California?” (“If you are opposed to a thing these days,” one frustrated health-care advocate wrote, “the cheapest way to attack it is to call it ‘German.’ ”) The people of California voted it down. By 1919, John J. A. O’Reilly, a Brooklyn physician, was calling universal health insurance “UnAmerican, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.”

Hm. This certainly sounds familiar, although these days, the word German has been replaced with the word socialist.

Fast Forward to Franklin D. Roosevelt and the New Deal. Once again, universal health care was bandied around as a right of all citizens. But opposition came, in the form of Southern Senators (who were mostly Democrats at the time, because Abraham Lincoln had been a Republican), concerned about the implications that a National Health Insurance (NHI) might have in their segregated societies. They aligned themselves with Republican senators and brought the American Medical Association (AMA) into the fold to put a block to this. President Roosevelt, concerned that other New Deal reforms would not pass if he pushed too hard on NIH, dropped it.

However, after World War II ended, President Truman tried to implement the national health insurance once again. His plan proposed a single insurance program that would cover all Americans with public subsidies to pay for the poor. Once again, according to an article published by the Kaiser Foundation:

Southern Democrats in key positions blocked Truman’s initiative, partly in fear that the federal involvement in health care might lead to federal action against segregation at a time when hospitals (in the South) were still separating patients by race. [The irony of the fact that it was President Obama who successfully brought universal health care into law is not lost on me.]

Also “an increasingly powerful AMA opposed National Health Insurance believing that physicians would lose their autonomy, be required to work in group practice models and be paid by salary or capitated methods. In addition, business and labor groups were not supportive, nor was the emerging private health insurance industry. “

Now the opposition was becoming stronger. The area of health care was being recognized as a potentially huge money making enterprise by the business class. But the government continued to plug away at the idea of universal healthcare. President John F. Kennedy presented the concept in the form of health care coverage for all those on Social Security. This was in 1962. President Lyndon B. Johnson was able to pass legislation creating Medicare/Medicaid programs to provide comprehensive health care coverage for people aged 65 and older, as well as for the poor, blind, and disabled in 1965. At this point, healthcare related spending started to skyrocket. Health care became a lucrative business.

In 1971, confronting the escalating costs of healthcare, President Richard M. Nixon backed a proposal that would require employers to provide a minimum level of health care for their employees, while maintaining competition among insurance companies, keeping medicare/medicaid for those over 65 and creating a pool insurance coverage for self-employed individuals. Senator Teddy Kennedy at the time was promoting a universal health care coverage directed and financed entirely by the government.

In hindsight, President Nixon’s proposal might have helped to contain health care costs. The issue that was being challenged by Senator Kennedy was that President Nixon’s program supported private insurance companies as the providers of health insurance. Kennedy’s proposal would take health care out of the private sector.

The debate that occurred between President Nixon and Senator Kennedy probably best epitomizes the struggle our country has had throughout its existence [go back to the acrimonious exchanges between Thomas Jefferson and Alexander Hamilton]. The debate has always centered around the rights of the citizenry and the rights of businesses to thrive and keep this country moving forward economically. What the debate never seems to quite latch onto is that there are some areas that are service areas by nature and other areas that fit under the intent of business. Health care is a service area. It should not be a money making enterprise. When the focus is on making money, the focus is no longer on service. [to be continued....]

It must be me. It must be. Either that or I have fallen through the rabbit hole, but…..

I received a robocall from AARP this afternoon. Someone claiming to be “Mary McDonough” or maybe “Mary McDonald” was wanting to know whether I would be willing to take a five minute survey on the Medicare/Medicaid issue. I stayed on the line. The recorded voice proceeded to present the following information: Question number 1 “Medicare cover all medical costs for ten years and then 90% of your hospital stay after that.” Press one if you want to leave things the same; press 2 if you want change; press 3 if you want change but not right away; press 4 if you do not want change.”

Quite honestly, I could not figure out how the options provided related to the statement, nor how the two parts of the statement related to each other, nor how the statement related to the medicare that I am familiar with which presently pays 80% of all medical expense (there is that donut hole with prescription drugs that does not fit the 80%, but….). So I felt I had no option but to hang up. But it bothered me and so I re-dialed the number to see if I could get some answers. A live woman came on the line.

I asked her if she was Mary McDonough. ”No. But how may I help you?” I asked her if I could speak with Mary McDonough. ”I’m sorry. I don’t know who that is.” ”She was the woman on the recorded survey call I received a few minutes ago.” She told me that these surveys are arbitrarily given and asked if she could help me with any questions. I explained that I did not understand the statement in the survey nor the options provided. She replied, “Would you like me to send you a written version of the survey?” I replied, “No. I am telling you that the way this information is presented does not make any sense and how are we expected to answer when the phraseology does not follow?” She informed me that I was not the only person dissatisfied with the wording of the survey. I suggested that AARP might want to consider this and change the way they present their survey. At that point, she said, “Eight out of 10 people don’t care.” ”Don’t care?” ”Yeah. They are apathetic.” ”Well, maybe if they were able to understand what was being asked they might not be apathetic? Shouldn’t AARP consider changing the wording if this wording is not making sense?” ”probably.” ”Well, who created the survey?” ”The supervisor.” ”Then may I speak to the supervisor?” ”You want to speak to the supervisor?” “Yes, please.”

A few minutes later, a 20 something and she had to be on this side of 25, answered the phone. I did not quite understand what she said, but I thought by the way she answered that I must be speaking with the assistant to the supervisor. ”Hello. May I speak with your supervisor?” I thought she said, “She’s not in. May I help you?” I ask her the questions about the survey. She asks me if I would hold a moment so that she can get the survey. After a bit, she comes back on the line and at this point, she claims herself to be the supervisor. She tells me that AARP puts out these surveys to get an idea of how people are thinking about certain issues.

I asked her if this survey was generated by AARP. ”No. We get them from another source.” ”What source is that?” ”I don’t know.” ”You don’t know what the source is to surveys that you put out in your name?” ”They are generated automatically.” What??!!?? “So what is the point of doing the survey, then?” “to get the information.” “But you don’t know who created the survey and you don’t know what the content of the survey is?” “No. Do you want to talk to the President?” ”To the President of AARP?” ”Yes.” “Sure.” I mean if that is the next in line and it might help with the circumstances, why not, think I.

Back on hold. A few minutes later, another 20 something sounding female answers the telephone. ”Office of Escalated Queries” she announces into the telephone. ”I’m sorry. Could you repeat that?” I ask. She does. ”So what is this office?” I continue. ”This is where inquiries of larger issues get answered.” Okay. So I once again go into the whole discussion about how this survey makes no sense. She informs me that surveys change according to the region, so she cannot help me with my query. ”We send these out globally.” she says. I reply, “Globally? I thought Medicare/Medicaid was an American issue.” ”Well, globally within the United States.” ”I thought I was being put through to the President’s office.” ”He does not have an office. I can give you an e-mail address to the Board of Directors and you can write them your concerns about the survey.” ”You will give me their individual e-mail addresses?” ”No. There is an office where you would send the e-mail.” ”Oh, I see and then I will get a reply that says something like: ‘Thank you for your recent inquiry. Because of the large volume of inquiries…..” “No,” replies 20-something number two. “They will give you an answer.”

“Who is on the board?” I ask. ”You want a list of who is on the board?” ”Yes, please.” ”Okay. There is Nancy Smith.” ”And what is her title?” ”Oh, no. I am not going to go into that. I don’t have time for that.” ”What did you say the name of your office was?” I ask once again. “Office of Escalated Inquiries.” ”So your job is to answer my questions, no?” ”Yes.” ”What is Nancy Smith’s title?” ”She doesn’t have a title.” ”Does she work for another organization? Is there some way that I can find out what her background is?” ”I don’t have that information.” ”Okay, then, who is the next person on the list.” She gives me the name of everyone who is on the board. There is no more information about their roles within the organization or what they may do outside of the organization. At some point, I learn that I am speaking to someone in Texas. “Texas?!? I dialed a 202 number.” ”You were transferred to me.” ”I was told I was being transferred to the President’s office.” ”I don’t know.”

Now I do have some colleagues in academia that scoff at the idea that AARP represents anyone in any age group let alone those 50+. And maybe I should conclude with this little interaction that they really are a joke. But I do find it unconscionable that an organization thatclaims to represent this demographic and is apparently one of the most powerful lobbyist for those 50+, would put out surveys that make absolutely no sense; and, that no one in the organization (or at least that I spoke with) seems to have any familiarity with their content let alone with whom to actually speak to because AARP has placed itself, claims itself, to be representative of our voice.

Beyond that, I now have an even larger escalated inquiry: What is AARP really AND what is their purpose?